Pregnancy loss: the grief others don't acknowledge

The discharge letter has two words on it and a diagnosis code. At home, in a drawer, lies the test with two lines; she hasn’t thrown it away because she doesn’t know what to do with it. Two days later her mother says on the phone: “You’re still young. At least now you know you can get pregnant.”

Her mother didn’t mean to hurt her. She meant to comfort her. But the sentence did something she didn’t expect: it told her daughter that what had happened wasn’t a real loss. That it was “still early”. That it was time to look ahead.

I have written more broadly about why some losses are not recognised as losses by those around us — from miscarriage to divorce to losing a job — in The grief nobody acknowledges. Here I want to stay with pregnancy loss alone, and with what makes it particular: it is the loss of someone known mainly to the mother, her body and her imagination. Medical questions — about causes, physical recovery or a future pregnancy — belong with your gynaecologist. This piece is about what remains once the medical part is over.

A common loss that is hardly ever talked about

Pregnancy loss is not rare. When Siobhan Quenby and colleagues brought together data from several countries in The Lancet in 2021, they estimated that around 15 per cent of recognised pregnancies end in miscarriage. So among the people you know, there is probably someone who has been through it — and you may not know.

That is the paradox. The loss is common, yet it is met with silence. Part of the reason is the habit of not talking about a pregnancy until the end of the first trimester, “just in case”. The habit is meant as protection: if something happens, you won’t have to explain to anyone. In reality it often means that a woman and her partner grieve without anyone knowing they are grieving.

The silence has another consequence. When something isn’t talked about, people assume it is rare. In a 2015 American survey, Jonah Bardos and colleagues found that more than half of respondents believed miscarriage was uncommon, while almost half of those who had experienced one reported feeling guilty. When you think it hardly happens to anyone, you quickly ask what you did wrong.

Everything that is lost

When people hear “miscarriage”, they often see a medical event. The woman who has been through it, though, loses several things at once — and some of them are visible to no one but her.

A pregnancy begins in the mind long before it begins to show. From the moment of a positive test, a child starts taking shape in your thoughts, and with it a new version of yourself. People work out the due date. They think about where the cot will go. They picture next summer. When the pregnancy ends, all of these images disappear at once.

That is why “it was only eight weeks” misses the point. What matters is not only how many weeks the pregnancy lasted, but how much future it already carried. For someone who waited years for a pregnancy, even a very early loss can be the loss of everything they had built in their mind. For someone else, a later loss may be experienced differently. The weight of a loss is not measured by the calendar but by attachment.

A body that doesn’t know it’s over

One of the things rarely talked about is that the body often doesn’t keep pace with the mind. A woman knows the pregnancy is gone, yet for a while her body still shows the signs it showed before. Hormones need time to settle. Some women describe feeling betrayed by their body twice: once because it didn’t keep the pregnancy, and again because it still behaves as if it had.

Physical recovery can be hard in its own right: bleeding, pain, hospital procedures that are routine for the health service but not for the person going through them. So it is right to ask your gynaecologist about anything that worries you physically — even when the question seems unimportant. I won’t give medical advice here. But I want to say that grief which settles in the body — tiredness, an emptiness in the belly, sudden tears over something trivial — is part of grieving and not a sign that you “can’t cope”. I have written about how grief lives in the body in Grief and the body: why we fall ill more often after a loss.

“What did I do wrong?”

Almost every woman who has lost a pregnancy asks herself this. Did I carry a bag that was too heavy? Was I too stressed? Did I have a glass of wine that evening, before I knew? Did I not want it enough?

Guilt after a loss is understandable. It gives a sense that something was in your hands — and if it was, you could prevent it next time. But this sense is often false. Only a doctor can answer the question of what caused the loss, and often the answer is that no precise cause can be found. For many people that “we don’t know” is harder than any answer, because it leaves a space that guilt immediately fills.

If you recognise this spiral, you may find it helpful to read Guilt after a loss: “I could have done more” and the short explanation of guilt in the knowledge base. You can’t argue guilt away. But you can learn to notice it as a form of grief — as love that doesn’t know where to go.

When grief mixes with fear

For a long time miscarriage was seen above all as a sad event that passes on its own. More recent research paints a more complicated picture. In 2020, Jessica Farren and colleagues followed several hundred women after early pregnancy loss. A month after the loss, almost a third reported symptoms consistent with probable post-traumatic stress: intrusive memories of the event, avoiding anything that reminds them of it, constant tension. For some women the symptoms were still present nine months later.

This does not mean that every pregnancy loss is a trauma. It does mean that reactions such as nightmares, sudden panic in the waiting room of a gynaecology clinic, or avoiding the baby section in shops can be more than “just sadness”. The difference matters, because traumatic reactions respond well to targeted forms of help. You will find a short explanation in the knowledge base under post-traumatic stress disorder. A diagnosis, however, can only be made by a professional — a psychiatrist or a clinical psychologist.

A partner who grieves differently

Pregnancy loss happens in a woman’s body, but it is a loss for both. A partner often grieves quietly — because nobody asks how he is, because it seems he has to be strong, or because he himself isn’t sure he has a right to grieve. When the loss is not acknowledged for the mother, it is acknowledged even less for the father.

So a couple can drift apart within the same loss. A conversation might look like this (composed, not a real person):

“You went back to work on Monday as if nothing had happened.”
“Because I didn’t know what to do at home. You were crying and I couldn’t fix anything.”
“I didn’t want you to fix anything. I wanted you to be sad with me.”
“I was. Just in the car, where you couldn’t see me.”

Nobody in this conversation is grieving the wrong way. There are two ways of grieving that can’t see each other. Women often grieve more openly, with words and a need to share; men more often through action, work and withdrawal. This is not a rule, but it is common. I have written about how a couple can find each other across such differences in Grieving as a couple: why you grieve differently.

In relational family therapy, in which I am training, we are also interested in what each partner has brought about loss from their own family. Was grief at home expressed out loud or in silence? Did grandmothers and great-grandmothers have pregnancy losses that were never spoken of? It often turns out that the previous generation had its own silent losses, and that the silence was simply inherited. In the 90-minute session A Look into the Past, we draw such patterns into a genogram — and sometimes it becomes clear for the first time that she is not the first in her family to carry this.

Dates that only you know

The people around you who knew about the loss are usually close in the first days. After a few weeks they go back to everyday life. And that is when the dates arrive that nobody else has in their calendar.

The hardest is often the due date. The day a child should have been born passes like any other day — at work, in a meeting, in the supermarket. Many women and many couples describe being hit harder by this day than they expected, precisely because nothing marked it on the outside. It is similar with the anniversary of the loss and with the first holidays that would have been celebrated differently. How to get through dates that others don’t notice is the subject of Anniversaries, holidays and the empty chair.

It helps to know the dates in advance and prepare for them: take a day off if you can, or at least know that the day will be harder and tell someone it will be harder. It doesn’t have to be anything big. Even a message to a friend — “tomorrow would have been the due date” — can mean you don’t spend that day alone.

Exercise: giving the loss a place

Pregnancy loss often lacks what other losses have: a ritual, a place, a name. This exercise doesn’t replace them, but it can be a small beginning. You can do it alone, with your partner, or with someone you trust.

1. Choose one object connected with the pregnancy — the test, a scan printout, a card you bought, or simply a sheet of paper. It doesn’t have to be big.
2. Write down what you had imagined. What kind of summer, what name, what moment. It doesn’t have to be beautifully written. What matters is that what existed in your mind takes shape outside you.
3. Write one sentence you would have liked to hear but didn’t. For example: “I’m so sorry you lost this.”
4. Decide where it will go. In a box, a drawer, under a tree, in a book. A place you can return to when you want to — and where you don’t have to stand every day.
5. If you like, tell someone you have done this. Not to get a reaction, but so that the loss is no longer only your secret.

For some people this exercise brings relief, for others tears, for some nothing in particular. All of that is fine. It is not a test of whether you are grieving “properly”.

Where this piece doesn’t apply

I also want to be honest about what I don’t want to claim.

Not every pregnancy loss is experienced as the loss of a child. After an early miscarriage some women feel mainly relief, others confusion, others almost nothing. If the pregnancy was unplanned or ambivalent, feelings can be mixed, even contradictory. None of these reactions needs correcting. There is no need to invent grief if it isn’t there.

There is no ranking of who is allowed to grieve more. An early loss is not “worth less” than a late one, and a late one is not necessarily “worse”. Particular forms of loss, such as stillbirth or ectopic pregnancy, have their own layers, but the weight of a loss always depends on what the pregnancy meant to the person.

The people around you are not always hostile. The mother at the start of this piece was not cruel. Most people who say the wrong thing simply don’t know what to say. If you want to help those close to you learn how to be with you, you can show them What to say to someone grieving, and what not to.

Grief is not an illness. Most people learn, over time, to live with a pregnancy loss through their own strength and the support of those close to them. Professional help is not a condition for things to turn out well.

When to look for more help

Help makes sense when sadness doesn’t ease after months, or even grows; when memories of the event overwhelm you; when you avoid anything to do with pregnancy and children to the point that your life is shrinking; or when a silence is building between you and your partner that you can’t break. If grief stays just as sharp after a long time, you may find When grief doesn’t pass: what prolonged grief disorder is helpful.

For prolonged low mood, sleeplessness or anxiety, see your GP; for physical concerns, your gynaecologist. If thoughts appear that it would be better if you weren’t here, seek help straight away: in Slovenia, the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am), the Samarijan helpline on 116 123 (24 hours a day), and in an emergency 112.

Sooner or later, many couples find themselves facing the question of a new pregnancy after a loss, and the fear that comes with it. That is the subject of Pregnancy after loss: the fear that lasts until birth. How to go back among colleagues after a loss is described in Returning to work after pregnancy loss: what to say, to whom, and how to get through the first weeks.

If English is your preferred language, I also work with English-speaking clients in person in Ljubljana.

What to remember

• Pregnancy loss is common — around 15 per cent of recognised pregnancies end in miscarriage — yet it is rarely talked about.
• With the loss you lose not only the pregnancy but also the child in your mind, the future, trust in your body and a carefree outlook. The weight of a loss is not measured in weeks.
• Guilt is a frequent companion, but often a false one. Only a doctor can answer the question of cause.
• Some women also develop symptoms of post-traumatic stress; these differ from sadness and respond well to targeted forms of help.
• Partners often grieve differently. Dates such as the due date are easier when you don’t carry them alone.

You will find a short explanation of the concept in the knowledge base under pregnancy loss.